Integration of Primary and Community Care (Committee Report)

Baroness Barker Excerpts

Thursday 9th May 2024 Lords Chamber

[Baroness Barker (LD)]

My Lords, I too pay tribute to the noble Baroness, Lady Pitkeathley. She and I have sat on a number of Select Committees in recent days, and I have to say that she was excellent as the chair of this committee. She steered us through the depression of weeks on end of people coming to tell us how the IT problems in the NHS were really difficult—and somebody else’s fault. She also took us through the days when people came from NHS England to tell us how perfect the situation was, and how our fears were groundless.

The noble Baroness, Lady Redfern, and I, week after week, bowled questions to people about IT, data-sharing and data governance, and I do not think we ever got a straight answer. Nor does the Government’s response deal with a critical question: who is responsible for the co-ordination of patient data? We can talk about anything we like, but until that question is answered and can be answered by everybody, we are going round in circles—and so are patients.

In preparation for this debate, I went on to the new NHS information portal. There is a lot of good stuff and good guidance on there, but nothing sufficiently definitive, as yet, to lead us out of the central problem: the responsibility of GPs to be the guardians of data. Such is the amount of patient data they have to deal with and co-ordinate that they are drowning in the system. As we have heard, they are having to deal with different IT systems. I know the noble Lord, Lord Altrincham, talked up Manchester, but I urge him to recall that, while Greater Manchester was recording increased health outcomes, two of the boroughs were not. Those boroughs were Oldham and Rochdale, areas I happen to know extremely well, and where for decades there has been a lack of GPs and community health staff.

In London we still have major hospitals that cannot talk to each other because they run on different IT systems. It is as simple as that. Therefore, unless and until we can go back and deal with some of those issues, which we flagged up in our report, we are on a hiding to nothing.

We know that the Pharmacy First programme is being rolled out. Only last week, in a report in the Guardian, pharmacists were cited as saying that they are not being given data. I think this is because GPs are being highly cautious and reluctant to pass on information in case they are held responsible for a data breach.

There are other parts of the health service in which that same problem comes up again—ophthalmology and audiology. Most people who have a problem with their eyes go to an optician, not a GP. The opticians do tests, then they refer somebody to a GP and, if there is a problem, they are sent to the ophthalmology department where, several months later, they go through exactly the same tests and get the same results. The same thing happens in audiology. The story of audiology is not one of the private sector and the NHS working together in a triage system; it is a story of delay, duplication and waste. If we cannot get it right for two conditions for which we have systems that could be put together quite easily—provided a data protocol was established—how will we do it for something such as complex neurological conditions, or some of the conditions that the noble Baroness, Lady Redfern, referred to in connection with old age?

I take the opportunity to say that noble Lords should listen to Hanif Kureishi talking this morning on the “Today” programme about what happened to him when he had a blocked catheter, and how he nearly ended up being unnecessarily blued and two’d into A&E, all because somebody could not find a community nurse. They did at the last minute, and he was sorted out.

One of the things we did not manage to get down to in the report, because we were so busy talking to all the GPs who could not sort out these data problems, is the lack of community health staff and the lack of local authorities that know where the health deficits are in their area, working in partnership with primary healthcare staff. I was sitting in an NHS hospital yesterday and I noticed a screensaver that read, “Confidentiality of patient data is everybody’s responsibility”. What it did not say is, “Co-ordination of patient data is nobody’s responsibility”. That is the issue we looked at and on which we came up with several recommendations. It is a great shame that the Government did not listen.